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Hepatitis A

Outbreak

Outbreak of Hepatitis A in North Carolina

Multiple states have reported large outbreaks of hepatitis A associated with person-to-person transmission. Cases have occurred primarily among three risk groups: (1) persons who use injection or non-injection drugs; (2) persons who are experiencing homelessness; and (3) men who have sex with men. North Carolina is experiencing an outbreak of hepatitis A as described below, though not of the same magnitude as some other states.

Hepatitis A can be prevented by a safe and effective vaccine.  If you are in one of the risk groups described (a person experiencing homelessness, a person who uses injection or non-injection drugs, or a man who has sex with men) or if you had contact with someone with hepatitis A, contact your health care provider or local health department about hepatitis A vaccine.

Additionally, always wash your hands with soap and water after going to the bathroom, after changing diapers, and before preparing meals for yourself and others.

North Carolina Hepatitis A Outbreak-associated Cases, Past 6 Months March 24, 2021 - September 24, 2021

Cases Hospitalizations Deaths
387 251 (64.9%) 11 (2.8%)
County Cases
Rate per 100,000
Population
Alamance 1
0.6
Alexander 8
22.0
Ashe 6
22.6
Buncombe 7
2.6
Burke 26
29.7
Cabarrus 15
6.6
Caldwell 15
18.6
Catawba 29
18.1
Chatham 3
3.9
Cherokee 15
52.1
Clay 2
18.0
Cleveland 20
20.1
Durham 6
1.8
Forsyth 4
1.0
Franklin 1
1.5
Gaston 80
35.1
Graham 6
74.7
Haywood 2
3.2
Iredell 4
2.1
Jackson 2
4.6
Lee 3
4.7
Lincoln 19
21.9
Macon 1
2.2
McDowell 15
68.1
Mecklenburg 17
1.5
Montgomery 3
11.7
Moore 2
2.0
New Hanover 3
1.3
Onslow 1
0.5
Orange 2
1.3
Polk 2
10.3
Randolph 3
2.1
Richmond 16
37.3
Rockingham 1
1.1
Rowan 26
17.7
Rutherford 2
3.1
Stokes 17
37.3
Surry 2
2.8
Union 2
0.8
Wake 2
0.2
Wilkes 13
19.7
TOTAL 387
13.7

Figure 1: Confirmed outbreak-associated cases of hepatitis A in North Carolina, county map: March 24, 2021 – September 24, 2021 (n=387)Map of Hepatitis A Cases

Figure 2:Confirmed outbreak-associated rates of hepatitis A in North Carolina, county map: March 24, 2021 – September 24, 2021 (n=387)Map of Hepatitis A Rates per 100,000 Population

Case Definition

Clinical Description

An acute illness with a discrete onset of any sign or symptom consistent with acute viral hepatitis (e.g., fever, headache, malaise, anorexia, nausea, vomiting, diarrhea, and abdominal pain), and either a) jaundice, or b) elevated serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels.

Case Classification

Confirmed:

  • A case that meets the clinical criteria and is IgM anti-HAV positive*, OR
  • A case that has hepatitis A virus RNA detected by NAAT (such as PCR or genotyping) OR
  • A case that meets the clinical criteria and occurs in a person who had contact (e.g., household or sexual) with a laboratory-confirmed hepatitis a case 15-50 days prior to onset of symptoms

*And not otherwise ruled out by IgM anti-HAV or NAAT for hepatitis A virus testing performed in a public health laboratory

North Carolina Outbreak Case Definition

Outbreak-associated case:

An acute case of hepatitis A meeting the confirmed case classification with onset on or after January 1, 2018 in a North Carolina resident who:

  1. Reports at least one of the following risk factors: homelessness, drug use (injection or non-injection), or MSM status; OR
  2. Has a hepatitis A genotype that matches a genotype predominant in a recent or current US hepatitis A outbreak; OR
  3. Is epidemiologically linked to a person meeting one of the above criteria.

 

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